Ankle replacement, also known as total ankle arthroplasty, is a surgical procedure used to treat end-stage ankle arthritis that causes severe pain, stiffness, swelling, and difficulty walking despite non-surgical treatments. Unlike ankle fusion, which permanently locks the joint, ankle replacement is designed to relieve pain while preserving ankle motion. It is most commonly performed for arthritis caused by prior injury (post-traumatic arthritis), rheumatoid arthritis, or advanced osteoarthritis when symptoms significantly limit daily activities. Before surgery, patients undergo a comprehensive evaluation including physical examination, X-rays, and often CT or MRI imaging to assess bone quality, alignment, and joint damage. Ankle replacement is typically performed under general or spinal anesthesia and usually requires a short hospital stay. During the procedure, the surgeon makes an incision at the front of the ankle, removes the damaged cartilage and bone from the tibia (shin bone) and talus (ankle bone), and implants artificial metal components on each side of the joint. A durable plastic spacer is placed between the metal surfaces to allow smooth, controlled motion. Depending on the patient, the implant may be fixed-bearing or mobile-bearing to optimize movement and stability. After surgery, the ankle is protected in a splint or boot, and weight-bearing is limited for several weeks to allow proper healing. Pain and swelling are expected early but gradually improve with medication, elevation, and rest. Physical therapy plays a critical role in recovery, focusing on restoring range of motion, strength, balance, and gait mechanics. Weight-bearing is introduced gradually under surgeon guidance, often progressing over 6–12 weeks. Long-term outcomes are generally favorable, with most patients experiencing significant pain relief and improved function compared to preoperative symptoms. Ankle replacement allows for more natural walking than ankle fusion and helps reduce stress on neighboring joints. However, high-impact activities such as running and jumping are discouraged to protect the implant. While ankle replacements do not yet have the same longevity as hip or knee replacements, modern implants show good durability and function for many years when patients follow activity recommendations and postoperative care guidelines.